Increased Incidence of Gastrointestinal Bleeding Following Implantation of the HeartMate II LVAD

Stern, David; Kazam, J. Jacob; Edwards, P.; Maybaum, Simon; Bello, Ricardo; D’Alessandro, David A.; Goldstein, Daniel J.

doi:10.1111/j.1540-8191.2010.01025.x

Cited by 179 publications

(139 citation statements)

References 23 publications

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“…DPE was discontinued after August 2009 as dual antiplatelet therapy was felt to be unnecessary because of a high incidence of GIB. 8 In September 2011, our institution switched to high-dose ASA for all CF LVADs after we observed several thrombotic events in patients supported by the HeartWare Ventricular Assist Device.…”

Section: Study Populationmentioning

confidence: 99%

Antiplatelet Therapy and Adverse Hematologic Events During Heart Mate II Support

Saeed

Shah

Kargoli

et al. 2016

Circ: Heart Failure

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Background — Hematologic adverse events are common during continuous flow left ventricular assist device support; yet, their relation to antiplatelet therapy, including aspirin (ASA) dosing, is uncertain. Methods and Results— A single-center retrospective review of all patients supported by a continuous flow left ventricular assist device (Heart Mate II) from June 2006 to November 2014 was conducted. Patients were categorized into 3 groups: (1) ASA 81 mg+dipyridamole 75 mg daily (n=26) with a target international normalized ratio (INR) of 2 to 3 from June 2006 to August 2009; (2) ASA 81 mg daily (n=18) from September 2009 to August 2011 with a target INR of 1.5 to 2; and (3) ASA 325 mg daily from September 2011 to November 2014 with a target INR of 2 to 3 (n=70). Hemorrhagic and thrombotic outcomes were retrieved ≤365 days after implantation. Cumulative survival free from adverse events was calculated using Kaplan–Meier curves and Cox proportional hazard ratios were generated. Hemorrhagic events occurred in 6 patients on ASA 81 mg+dipyridamole (26%; 0.42 events per patient year; mean INR at event, 2.2), 4 patients on ASA 81 mg (22%; 0.38 events per patient year; mean INR at event, 2.0), and in 38 patients on ASA 325 mg (54%; 1.4 events per patient year; mean INR at event, 2.2); P =0.004. Patients on ASA 325 mg had a higher adjusted hazard ratio of 2.9 (95% confidence interval, 1.2–7.0 versus ASA 81 mg+dipyridamole; P =0.02) and 3.4 (95% confidence interval, 1.2–9.5 versus ASA 81 mg; P =0.02) for hemorrhagic events. Thrombotic events rates were not different between groups. Conclusions— High-dose ASA in Heart Mate II patients treated concomitantly with warfarin is associated with an increased hazard of bleeding but does not reduce thrombotic events.

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Section: Study Populationmentioning

confidence: 99%

Antiplatelet Therapy and Adverse Hematologic Events During Heart Mate II Support

Saeed

Shah

Kargoli

et al. 2016

Circ: Heart Failure

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“…Continuous-flow LVADs appear to be of similar risk to pulsatile LVADs, even with variable adherence to INR targets [27]. A combination of prophylactic aspirin therapy (with or without an additional antiplatelet) and warfarinisation to an INR of 2-3 (or even 1.5-2.5) is reasonably employed in continuous-flow devices, but is dependent on the LVAD manufacturer [2,26,28,29]. Thromboembolic prophylaxis increases the risk of bleeding [28].…”

Section: Reviewmentioning

confidence: 99%

Lvads: A Two-Sided Dilemma when Buying Time for Heart Transplantation

Binks¹

2017

SOJS

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“…40 Gastrointestinal bleeding has been frequent, and may be related to de novo arteriovenous malformations or an acquired von Willebrand's deficiency. 41,42 Another unexpected challenge with continuous flow has been the chronic development of aortic valvular insufficiency. 43 Some surgeons now consider suturing of the aortic valve at the time of LVAD implant.…”

Section: Lvad Complications-expecting the Unexpectedmentioning

confidence: 99%